December 11, 2008

Battlefield Acupuncture

The technique is proving so successful that the Air Force will begin teaching "battlefield acupuncture" early next year to physicians deploying to Iraq and Afghanistan, senior officials will announce tomorrow.

[…]

Using tiny needles that barely penetrate the skin of a patient's ear, Air Force doctors here say they can interrupt pain signals going to the brain.

Their experience over several years indicates the technique developed by Col. Richard Niemtzow, an Air Force physician, can relieve even unbearable pain for days at a time.

And I thought this cartoon was a joke.

Perhaps it was. But it’s not anymore. This military doctor is apparently claiming he can interrupt pain signals going to the brain for days at a time. And he is relying on "experience over several years" - presumably because actual studies suggest that acupuncture is nothing more than a highly elaborate placebo. For example:

Interesting! Maybe there is something to this afterall. I mean the military is claiming that they can interupt pain signals with acupuncture is probably not a lie! I don't think these soldiers are playing along. Either it works or it doesn't.

I never thought the problem was whether or not acupuncture "worked", but the bogus explanations as to how, like chi flow and all that claptrap. It should be pretty easy to determine whether it is an effective treatment for trauma under field conditions. If it is, use it. I'd just be interested in how they determined that it was effective. I didn't see any references to studies.

this is as silly as saying "they are going to ride on unicorns when charging on enemy armies".
I wonder who lobbied or pushed political influence and power to get the idea approved. why don't they train soldiers on how to use the force then?. or maby give them a scroll with the spell "level 1 cure" so they can learn it.
gee, I bet casting "cure all" or using the force to heal works as wonderfully as acupunture, right?.

now seriously, this is a dangerous precedent, in the collective mind of society, is like "the government say it's true!, see?, so astrology, talking to the dead, and the secret are true too!".

Having the military involved is no guarantee it works. For example, they spent $20 million on Stargate Project before realizing that "Psi" doesn't work. But as far as I know, no injured military personnel suffered directly because of Stargate.

It is pretty clear that acupuncture works to alleviate pain. Of course it doesn't work because of energy fields or balance chi or other BS. Haven't seen evidence that it works for stuff other than pain. But, you can block the effects of acupuncture using opiate antagonists done in a blinded fashion. That is pretty good evidence it works for pain. It must somehow release endorphins.
Of course placebo is something very different. Placebo is very interesting. It is very powerful. In placebo controlled studies in Parkinson's disease, the group getting placebo always shows clinical benefit. If you do f-dopa PET scans, looking at the dopamine content in the brain, the dopamine content in the brain is increased for about 6 months! That is pretty amazing. Somehow, the patient thinking that he was getting an active dopamine agent, is able to increase the dopamine content in the brain and get benefit.
This is a link to a similar study (sorry, new here and don't know if there is a better way to post links):http://74.125.45.132/search?q=cache:wsYI1GblBxkJ:www.sjsu.edu/faculty/gerstman/StatPrimer/delaFeunte-Fernandez.pdf+placebo+dopa+PET+scan&hl=en&ct=clnk&cd=19&gl=us&client=safari

The problem is that acupuncture doesn’t really deliver for the kinds of serious injuries they might see in action. My responses to your specific points follow.

It is pretty clear that acupuncture works to alleviate pain.

Read the links I put at the bottom of the post. They show it doesn’t work better than sham acupuncture – ie it’s placebo. And even then it’s minimal. Hardly enough for battlefield injuries.

Of course it doesn't work because of energy fields or balance chi or other BS. Haven't seen evidence that it works for stuff other than pain. But, you can block the effects of acupuncture using opiate antagonists done in a blinded fashion. That is pretty good evidence it works for pain.

No, evidence it works for pain would be some actual evidence that it actually works for pain.

It must somehow release endorphins.

I don’t know about “must”. It is possible, although I’m not aware of any studies that have shown that. But again, hardly what I’d want if I was seriously injured.

Please take a read of Orac today - Battlefield acupuncture revisited: Only the thinnest of gruel will do – it explains in more detail why this is such a bad idea. In summary – once you stop requiring real evidence something works, you’ll believe in anything. Just read the drivel this Air force doc believes in. I believe we all deserve better but our troops in battle especially so.

btw, if you need to format anything such as hyperlinks, please take a look at How To Format Comments – I hope that will be of some help.

So sorry about the formatting. It looks bad on my computer too. I'll read the instructions on how to post links.
I think the problem with using sham needling as a control technique is that it makes the assumption that there is something special about the sites they usually needle. There are numerous randomized controlled studies supporting benefit for pain conditions and some use a sham where the needle is only minimally inserted and the patients are unable to say whether they had "real" acupuncture. But I suspect there is simply not a perfect control experiment to do. There are many fields where there are not perfect controls. For example, in Parkinson's Disease (my field), we know that deep brain stimulation works. However there is no perfect control to test it since doing a sham surgery where a needle is inserted in a person's brain to simulate the surgery, will give significant benefit because the trauma from the needle actually gives benefit.
We wont get anywhere in medicine if we only practice based on perfectly designed studies. Sometimes, doing the "perfect" study is not possible for ethical reasons.
Now don't get me wrong. It is simply crazy to use acupuncture in a battle field situation expect perhaps if no analgesics are available. Then who cares if it is a placebo effect or not. Also, I never have referred patients for acupuncture because the standard treatments I use in my patients work so well.
I am surprised you are not convinced with the studies using opiate antagonists.
Again, sorry about the last post making things look weird.